Sphincter saving resection after preoperative chemoradiation for T3 carcinoma of the lower rectum

ABSTRACT

Surgical treatment has evolved over the past ten years particularly for cancer involving the mid and lower third of the rectum. carcinomas of the lower third of the rectum are usually treated by abdominoperineal resection especially for T3 lesions. Few data are available evaluating Concomitant chemotherapy with preoperative radiotherapy for increasing sphincter saving resection [SSR] in low rectal cancer The purpose of this study was to evaluate the possibility of SSR for T3 cancers of the lower third of the rectum and subsequently the complication oncologic and functional results of preoperative chemoradiation followed sphincter saving procedure is assessed and determined. Twelve patients with T3 rectal carcinoma were treated by preoperative radiation with concomitant chemotherapy were included in the study. All patients had invasive adenocarcinoma of the rectum and underwent staging before treatment by endorectal ultrasonography All patients underwent conservative surgey after chemoradiation for low rectal cancer tumors located at a mean of 5 cm from the anal verge. Transanal intersphincteric resection was done in 7 patients. A colonic J-pouch was done in 2 patients. All patients had a defunctioning loop ileastomy. There were no deaths related to preoperative chemoradiation or surgery. Morbidity occurred in 33.3% of patients was complicated by a pelvic abscess that responded to conservative treatment. The other complications local recurrence at the anastomosis site at 13 months and was treated by salvage APR After preoperative chemoradiation all the tumors appeared as an ulcerative scar without any vegetative component. The mean tumor size in fresh specimens was 3.6 cm range [l-9]. The mean distal margin, assessed in fresh specimens without traction, was 23 +/- 8 mm [range 10-40]. The mean radial margin assessed microscopically was 8 +/- 4 mm [range 1-20]. Both distal and radial margins were negative [> 2 mm] in 11 [91.6%] patients; they were positive [patient. The pathologic stages of the 12 patients after surgey, were as follows pT0N0 in 4 patients [33.3%], pT0N1 in 3 patients [25%], pT2N0 in 4 patients [33.3%], pT2N1 in 1 patient [8.3%] and there were no cases with pT3N0, pT3N1 or M1 After preoperative chemoradiation the overall downstaging rate, including both primary tumor and node downstaging was 75% [9/12]. A pathologic complete response of TRG1 was achieved in 41 6% [5/12] and a partial response of TRG2 was achieved in 33.4% [4/12] and a response of TRG3 in 25% [3/12] of patients. These results suggest that preoperative radiochemotherapy allowed sphincter-saving resection to that performed with good local control and good functional results in patients with T3 low rectal cancers, that would have required abdominoperineal resection in most instances